1. Field of the Invention
The present invention relates generally to surgical instruments and procedures and, more particularly, to an apparatus and method for suturing an opening in anatomical tissue, such as a puncture site created for introduction of instruments during endoscopic and other minimally invasive procedures.
2. Description of the Background Art
Endoscopic and minimally invasive medical procedures, such as laparoscopy, have become widely accepted for surgery and diagnosis due to the associated advantages relating to reduced trauma and hospitalization time. The performance of an endoscopic procedure, however, requires the creation of one or more puncture sites through a wall of an anatomical cavity to permit introduction of instruments such as portal sleeves or cannulas, endoscopes, ligating appliers, forceps, cauteries and the like into the anatomical cavity. The puncture sites are normally created by means of a penetrating instrument including an obturator, such as a trocar, disposed within a portal sleeve such that, after the penetrating instrument has penetrated into the anatomical cavity, the obturators are withdrawn leaving the sleeves in place to form portals in the cavity wall. Once the endoscopic procedure has been completed, the sleeves are withdrawn and the puncture sites are closed.
Herniation through an improperly closed puncture site in the wall of an anatomical cavity is one of the rare postoperative complications associated with endoscopic procedures that can lead to significant morbidity. With the increased use of endoscopic procedures and the use of larger endoscopic portals an increase in the incidence of such complications can be expected. Even where a defect is small, there is still the possibility of small bowel entrapment in a Richter's type hernia at the site of introduction of the trocar or other penetrating instrument. Hence, it is important that the puncture site be closed or approximated following removal of the endoscopic instruments.
While complications such as herniation and small bowel entrapments can be avoided by suture of the puncture site in the cavity wall, this involves a time consuming and trauma causing procedure whereby the defect in the cavity wall is enlarged and manipulated to provide access for performing suturing of the interior layers, such as the fascia, using standard curved suturing needles and lengths of suture material. Additionally, in other medical procedures, such as anastomosis, bladder reattachment and repair of congenital or noncongenital defects in the wall of an anatomical cavity such as the abdomen, bowel, small blood vessels such as veins and arteries, epidural, plural and subarachnoid spaces, heart ventricles and spinal and synovial cavities, it is important to quickly and securely repair the opening or separation in the anatomical tissue. In minimally invasive procedures in particular, suturing of the anatomical tissue is both time consuming and difficult as the suture needles and lengths of suture material must be grasped using instruments manipulated remotely from the operative site through narrow cannulas or sleeves.